Slavic Village effort takes HIV prevention to the neighborhood level in hopes of reversing trend

by Rachel Dissell

(Plain Press, February 2021)         On a crisp fall day, a small group of masked community researchers fanned out on the streets of Slavic Village to ask residents a few questions about their sex lives. 

  The effort was one part of a plan to understand why the Cleveland neighborhood has seen higher levels of new HIV cases diagnosed over the past five years, despite an overall downward trend in Cuyahoga County. The clipboard-toting volunteers also popped into local stores to record condom prices and availability. 

  The Slavic Village ZIP code, which also includes the Union-Miles neighborhood, was one of two in the county to report 50 or more new HIV diagnoses between 2015 and 2019, according to the most recent Ohio’s HIV Surveillance program. (The other ZIP code, 44102, includes the Detroit Shoreway and Edgewater neighborhoods.) 

  Slavic Village’s hyper-local response to the rise in cases, aided by a $25,000 AIDS Funding Collaborative grant, mirrors a national trend in prevention and treatment efforts, which until recently were orchestrated at the city or metro level. 

  It also means combatting two viruses at once: HIV, which has lingered stubbornly for decades, and the coronavirus that has ripped through a neighborhood already exhausted from efforts to tackle cycles of generational poverty, food insecurity and low literacy. 

  Viruses don’t respect neighborhood boundaries, but learning more about how HIV is being transmitted in Slavic Village is key to tailoring a prevention strategy, said Bob Eckhart, a public health practitioner who has worked on HIV prevention and treatment and AIDS services since the 1980s, when he helped catalyze the local and national response. 

Hearing from the community

  Though it can be awkward to ask questions about a person’s sex life or what protection they use, hearing directly from residents helps to avoid assumptions, said Autumn Franz, a recent John Carroll University graduate who helped to organize the community “research mob” and collect surveys from about 50 residents to learn more about how often they use protection during sex. 

  It’s particularly important in Black communities, where it can be harder to come out as gay or bisexual, or where transgender women of color are not always part of the conversation, Franz said.

  Another challenge is figuring out who can help pay for and deliver prevention messages and services to the neighborhood’s 22,000 or so residents, many of whom are low income. 

  When Eckhart started reaching out to interview community leaders, most were surprised to hear HIV infections were on the rise.

  “People haven’t thought about AIDS and HIV in a long time,” he said. What he heard was ‘we just didn’t know.’” 

  One thing, though, was clear: Residents don’t want people to come in from outside the neighborhood to address the issue. 

  That makes sense to Gary Scofinsky, who has called Slavic Village home since 1995. Despite all of its pressing problems, it’s a place that has a strong network of neighbors who take care of their own, he said.

  Scofinsky is known for his massive garden operation, which provides vegetables like kohlrabi and eggplant for neighbors, and jalapenos for employees at the nearby Dollar General, where he often shops. 

  The 54-year-old, who has lived with HIV for more than two decades, believes one way to raise awareness might be to use neighbor networks to pass out literature and condoms, particularly to younger residents who might be harder to reach or who aren’t openly gay or bisexual and have concerns about people passing judgment on them.

  Scofinsky also thinks there should be more outreach at local drug rehabilitation centers. Often, he said, people are careful about needle sharing but not as cautious about unprotected sex when drinking and using drugs. 

  Scofinsky, who is partially paralyzed due to a violent physical attack decades ago, says he has mostly stayed inside during the pandemic. But once it is safe, he’d volunteer to hand out condoms or answer questions at community events. 

  “There’s a lot of people who know me,” he said. “They might hear it coming from me.”

Local voices key

  Information gleaned from community research can be invaluable, said John Barnes, executive director of Funders Concerned About AIDS.

  For a variety of reasons, it is harder to give federal money to small neighborhood groups. The formulas used to measure the problem and dole out the money have also disadvantaged communities with new or emerging outbreaks, he said. 

  In some ways, the work to eradicate HIV has been hampered by strides in treating the virus. “The success of treatments and prevention strategies have lessened the sense of urgency,” Barnes said, though the people currently at the highest risk for infection are among the most marginalized. 

  The grant to University Settlement was one of the first the Cleveland AIDS Funding Collaborative gave for a “neighborhood deep dive,” said Julie Patterson, director of the collaborative.

  It has since awarded “catalyst” grants to several other community or neighborhood organizations that might not qualify for larger federal grants with more rules and restrictions, Patterson said.

Brainstorming solutions

  COVID-19 halted the door-to-door part of the community research as infections climbed this fall and winter, so the group went virtual, organizing a Zoom call recently with nearly a dozen residents: mothers, artists, health care workers, a young couple with a chubby-cheeked baby. 

  From their couches and kitchens, they brainstorm potential places where free condoms could be distributed in the community, such as the rapid transit station on E. 55th Street or a blood plasma donation center on Broadway Avenue. They also discussed how to best weave conversations about sexual health into the fabric of neighborhood events that already exist. 

  While most agreed free condoms should be widely available, they also thought opportunities for discreet testing would be helpful for those unwilling to get tested at a doctor’s office or at the AIDS Task Force office, which features its name on a large sign over the door. 

  It’s also essential to acknowledge men are in relationships with women and have sex with other men on the “down low” because it is not culturally acceptable, said Mimi, 41, who runs a church-based group for mothers of all ages. (She asked that only her first name be used.)

  The place to start, most agreed, was to raise awareness about how to prevent HIV and reduce the stigma of talking openly about it.

  “People that I know have shut down and they have feared for their lives because people may get angry and treat them a certain way, and so they are scared to let people know what is going on,” Tyra Jackson, 44, told the group. 

  “We know everybody is not going to be accepting,” said Jackson, who last year started an outreach organization called “The Caring.” 

  “But if we can get more people to be a little more welcoming, she said, “maybe we can make a difference and make people feel like they can come out and say, ‘Hey, I have HIV.’”

Editor’s Note:  This story is provided by ideastream as part of special community coverage of COVID-19 and funded by Third Federal Foundation and University Settlement.

Free condoms are available at the front desk at University Settlement in Slavic Village. The neighborhood is working on a strategy to combat an uptick in new HIV diagnoses in the past five years.

Sign up here to get free condoms mailed to your home. https://ohiv.org/positive/free-condoms/

In 2019, Cuyahoga County reported 158 new HIV diagnoses. The new diagnoses were overwhelmingly among men who had sex with men and who were Black and under the age of 35.

• 86% male (sex at birth)
• 67% identified as Black
• 63% under 35

Two Cleveland ZIP codes have the most new reported diagnoses of HIV between 2015 and 2019. 

Ohio Department of Health HIV Surveillance program

PHOTO BY TIME HARRISON FOR IDEASTREAM

 Cleveland’s Slavic Village neighborhood has seen an increase in new HIV diagnoses since 2015, according to state health officials. A project there aims to learn more about how the virus is being transmitted, to step up prevention and treatment, and to distribute condoms and other safer-sex products.